Primary Care Atrial Fibrillation Service: outcomes from consultant-led anticoagulation assessment clinics in the primary care setting in the UK
| Autor: | Lee Panter, Gareth J. Wynn, Moloy Das, Paulus Kirchhof, Neil Connor, Joseph D Mills, R. Taylor, Dhiraj Gupta |
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| Rok vydání: | 2015 |
| Předmět: |
medicine.medical_specialty
Vitamin K Consultants General Practice Population MEDLINE Primary care Cardiovascular Medicine Risk Assessment Atrial Fibrillation medicine Humans Intensive care medicine education Stroke education.field_of_study Primary Health Care business.industry Research Warfarin Anticoagulants Atrial fibrillation General Medicine Health Services medicine.disease Cohort Emergency medicine Patient Compliance Health Facilities business Risk assessment medicine.drug |
| Zdroj: | BMJ Open |
| ISSN: | 2044-6055 |
| DOI: | 10.1136/bmjopen-2015-009267 |
| Popis: | Objective Stroke-risk in atrial fibrillation (AF) can be significantly reduced by appropriate thromboembolic prophylaxis. However, National Institute for Health and Care Excellence estimates suggest that up to half of eligible patients with AF are not anticoagulated, with severe consequences for stroke prevention. We aimed to determine the outcome of an innovative Primary Care AF (PCAF) service on anticoagulation uptake in a cohort of high-risk patients with AF in the UK. Methods The PCAF service is a novel cooperative pathway providing specialist resources within general practitioner (GP) practices. It utilises a four-phase protocol to identify high-risk patients with AF (CHA2DS2-VASc ≥1) who are suboptimally anticoagulated, and delivers Consultant-led anticoagulation assessment within the local GP practice. We assessed rates of anticoagulation in high-risk patients before and after PCAF service intervention, and determined compliance with newly-initiated anticoagulation at follow-up. Results The PCAF service was delivered in 56 GP practices (population 386 624; AF prevalence 2.1%) between June 2012 and June 2014. 1579 high-risk patients with AF with suboptimal anticoagulation (either not taking any anticoagulation or taking warfarin but with a low time-in-therapeutic-range) were invited for review, with 86% attending. Of 1063 eligible patients on no anticoagulation, 1020 (96%) agreed to start warfarin (459 (43%)) or a non-vitamin K antagonist oral anticoagulant (NOAC, 561 (53%)). The overall proportion of eligible patients receiving anticoagulation improved from 77% to 95% (p |
| Databáze: | OpenAIRE |
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